HomeMy WebLinkAboutApplication - 161 RALEIGH TAVERN LANE 10/12/2006 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION of No RT#1
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Permit NO: Date Received i'O"" It--o
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Date Issued:
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IMPORTANT:Applicant must complete all items on this page
LOCATION /Ya / /� i},� To
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PROPERTMQWNER Print
MAP NPARCEL• //0 ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non-Residential
❑ New Building ❑ One family
Addition ❑Two or more family ❑ Industrial
Alteration No. of units:
❑ Repair, replacement ❑Assessory Bldg ❑ Commercial
❑Demolition
❑ Moving(relocation) ❑Other ❑ Others:
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
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Identification Please Type or Print Clearly)
OWNER: Name: 17 V,_. /?7 r �;,, 4 �— Phone:
Address: /6 / i9��� j-ti 7-
CONTRACTOR Name: Po ,*z,>,xrj,Q c,.67 c, ,- L L < Phone: 7S'
Address: 2 c ov x)6 zJ
Supervisor's Construction License: c) Exp. Date:
Home Improvement License: is / Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost :$ FEE:$
Check No.: Receipt No.:
Page I of 4
TYPE OF SEWERAGE DISPOSAL Swimming Pools ❑
❑ Tanning/Massage/Body Art ❑
Public Sewer ❑
Tobacco Sales Food Packaging/Sales ❑
Well ❑ ❑
/ Permanent Dumpster on Site
Private(septic tank,etc. 1(�' Electric Meter location to
project
NOTE: Persons contr cting with unregistered contractors do not have access to the guaranty fund
Signature ature of contract r �'' /�
Signature of Agent/Own
Plans Submitted ❑ Plans Waiv ❑ Certified Plot Plan ❑ tamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF-U FORM
DATE REJECTED DATE APPROVED
PLANNING& DEVELOPMENT Fl-
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION ❑ l' `
COMMENT
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—7' DATE REJECTED DAT ROVED /
HEALTH ❑ I�l L�
COMMENTS1-
FIRE DEPARTMENT -Temp Dumpster on site yes no
Fire Department signature/date \
COMMENTS
Zoning Board of Appeals: Variance,Petition No: Zoning Decision/receipt submitted yes
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Planning Board Decision: Comments
Conservation Decision: Comments
Water&Sewer connection/Signature&Date Driveway Permit
CERTIFIED PLOT PLAN
LOCATED IN NORTH ANDOVER,, MA .
THE,BONING DIST IS R2 SCALE: 1"=40' DA TEE 612712006
43,560 S.F.AREA 10/11/2006,10%20/2006
160'FRONTAGE Scott L. Giles R.P.L.S.
30'SETBACKS ALL AROUND Frank S. Giles R.RL.S.
50 Deer Meadow Road
North Andover, Mass.
190.(1'
LOT#23
PLAN #5913 IV.E.R.D.
44,710 S.F.q-1-
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150.0'
RALEIGH
I CERTIFY THAT w �
OFFSETS SHOWN ARE FOR THE USE
or
THE OFFSETS OF THE BUILDING INSPECTOR ONLY
SHOWN COMPLY AND SUCH USE IS FOR THE
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WITH THE ZONING
DETERMINATION OF`BONING ?; � 2
BYLAWS OF
CONFORMITY OR NON-CONFORMITY A �
NORTH ANDOVER w Zz LAWS b;
WHEN BUILT WHEN CONSTRUCTED." ,.,